余學峰：長期并發癥的管理是中國T2DM的最大挑戰

?

全球探索調查旨在調查臨床醫生（HCP）和2型糖尿病患者（PWD）對2型糖尿病（T2DM）管理的認知。這項調查以網絡為基礎，對來自13個國家的PWD（2100例）和HCPs（1400例）提出10項問卷調查。這項調查報道了來自中國226例PWD和100例HCPs的數據。±3%的差異有統計學意義，且±10%的差異為顯著差異。

該調查結果表明，中國的數據和全球的數據有差異。中國（89%）與全球（96%）相比，較少的HCPs認為體重管理（wt）是最大的挑戰，可能是因為中國的PWD與全球相比較少肥胖（以當地定義為基礎）。中國HCPs認為大血管并發癥（99%）和心血管（CV）風險（96%）管理是最大的挑戰；中國PWD同樣關心長期并發癥。中國與全球相比（63 vs 33%），注射療法（主要指胰島素）更加普遍，且減少低血糖方面有更大的挑戰（79% vs 66%）。

在PWD和HCPs的回答之間存在一些差異。僅有28%的PWD和46%的HCPs認為wt下降1-5%是有意義的，71%的PWD和54%的HCPs認為wt下降＞6%是有意義的。HCPs更加強調長期的wt下降，46%的HCPs（與26%的PWD相比）希望wt下降＞2年。PWD認為尿路感染（UTIs）和真菌感染是最難以接受的治療副作用，然而，醫生認為是低血糖。有趣的是，假如能伴有2.5%的的wt下降，相似數量的PWD（44%）和HCPs（40%）原意接受這些最難以接受的副作用（權衡風險/受益）。該研究同時還注意到情緒影響的認知差異，與PWD相比，多達兩倍的HCPs認為CV事件（29 vs 15%）和血糖管理（31 vs 12%）有負面情緒影響。

該研究發現，這些數據突出，在中國長期并發癥管理是T2DM問題的最大挑戰。與全球的結果相比，在中國，wt管理沒有被充分重視。PWD和HCPs在wt下降副作用和T2DM對情緒影響方面觀點的差異需要解決。

The EXPLORE Global Survey examined the perceptions of clinicians (HCP) and people with Type 2 diabetes (PWD) on T2DM management. EXPLORE was an internet-based 10-item questionnaire for PWD (N=2100) and HCPs (N=1400) from 13 countries. Data from 226 PWD and 100 HCPs from China are reported here. Differences of ±3% are statistically significant and ±10% meaningfully different.

There were differences in the China and global data. Fewer HCPs in China (89%) vs globally (96%) found managing weight (wt) the biggest challenge perhaps because Chinese PWD were less obese (based on local definition) than global PWD. Chinese HCPs found managing microvascular complications (99%) and CV risk (96%) the biggest challenge; PWD were similarly concerned about long-term complications. Injectable therapy (mainly insulin) was more common in China vs globally (63 vs 33%) and minimizing hypoglycemia was a greater challenge (79 vs 66%).

Several disconnects exist between PWD and HCPs responses. Only 28% of PWD vs 46% of HCPs thought wt loss of 1-5 % as meaningful; 71% of PWD thought wt loss of >6% as meaningful vs 54% of HCPs. HCPs placed more emphasis on long-term wt loss; 47% (vs 26% of PWD) wanted loss for ≥2 yrs. PWD perceived UTIs and yeast infections as the least acceptable therapy side-effect while clinicians identified hypoglycemia. Interestingly a similar number of PWD (44%) and HCPs (40%) would willingly accept the least acceptable side-effect if accompanied by a 2.5% wt loss (risk/benefit trade-off). Disconnects were also noted in perceptions of emotional impact; twice as many HCPs vs PWD identified risk of CV events (29 vs 15%) and managing blood sugar (31 vs 12%) to have a negative emotional impact.

These data highlight that management of long-term complications is the most challenging T2DM issue in China. Wt management is not as highly regarded by HCPs and PWD in China compared with global results. The disconnect between PWD and HCPs views on wt loss side-effects and emotional impact of T2DM needs to be addressed.

?

編輯： 葛根    來源：丁香園